Abstract
Increased carotid intima-media thickness (cIMT) is associated with CV events in adults and thicker cIMT is found in youth with CV risk factors including obesity. Which risk factors have the most direct effect upon cIMT in youth and whether obesity has direct or indirect effects is not known. We used structural equation modeling to elucidate direct and indirect pathways through which obesity and other risk factors were associated with increase in cIMT. Demographics, anthropometrics, laboratory and carotid ultrasound data were collected on 426 participants aged 17.5 at baseline (32% type 2 diabetes) and after 5 years of follow-up. Latent change score variables were defined by baseline and follow-up measurements. Latent baseline and follow-up cIMT, glucose variables were defined for each cIMT segmemt (common, bulb and internal), HbA1c, and fasting glucose. SAS 9.4 CALIS procedure was used for analyses with maximal likelihood estimation. Comparative fit index (CFI >0.9) and root mean squared error of approximation (RMSEA <0.1) were considered good model fit. At follow up, there were increases in BMI, MAP, LDL, TG, HDL, CRP and fasting glucose, decrease in fasting insulin and HbA1c (all p≤0.05). There was no increase in common, but significant increase in bulb (0.031 mm) and internal (0.027 mm) cIMT (all p ≤0.001). Significant direct effects on changes of cIMT were baseline MAP (β 0.23) and BMI z-score (β 0.16) plus change in glucose (β 0.37) and age (β 0.37; all p≤0.05). Change in MAP showed a trend in the model (β 0.14, p=0.10). BMI also had significant indirect effect (b 0.17) while non-HDL demonstrated no significant effect. We conclude that baseline adiposity drives increasing BP and glucose in high risk youth leading to accelerated accumulation of carotid atherosclerosis. Prevention of acquisition of obesity is critical in slowing development of CV disease. NIH R01 HL105591 (Urbina) and UL1 TR001425.
Published Version
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